In year four of my K20 award, I have completed one year follow-up evaluatin of 95 children ages 4 to 19 who have suffered moderate and severe closed head injury (GCS 3 TO 12). In addition to data accumulation and computer entry, data analysis and manuscript preparation have been the major objectives of this year's work. Symptoms of apathy and affective liability play an important role in the psychiatric picture that is seen after closed head injury. In study year one, I participated in the construction of two rating scales to measure childhood apathy and affective liability, twto constructs that had not been previously been measured in children. Two articles describing scale construction and their psychometric properties were published in PSYCHIATRY RESEARCH in 1996. Our head injury research group has selected aspects of the head injury data for hypothesis testing and statistical analysis. Preliminary statistical analyses have been incorporated into abstracts and poster presentations. These abstracts, among other, have presented previously unreported information about significantly higher prevalence of premorbid psychiatric disorders in the head injured population than in a reference population; of significantly higher incidence of new psychiatric disorder in the head injured population than in a reference population; psychiatric, demographic, and neuroimaging characteristics of children who have had psychiatric hospitalization after closed head injury; and psychiatric, demographic, and neuroimaging characteristics of children who develop obsessive-compusive symptoms after closed head injuries. Attention Deficit Hyperactivity Disorder (ADHD) is an important childhood mental disorder that appears after moderate and severe closed head injury. One area of focus is specifically relate to PCRU funding for MRI sedation. A rating scale has been constructed to evaluate MRI scan quality. An important objective of scale development was to devise a scale that would distinguish scan quality of MRI scans performed with sedation from quality of MRI scans preceded by behavioral training. An abstract describing this new scale and its psychometric properties has been submitted to the Radiologic Society of North America. This scale will have wide applicability wherever quality of MRI images is an important consideration. Moderate and severe closed head injury is a major public health problem in the U.S. Careful description and data analysis of psychiatric sequelae and neuroimaging data after these injuries lead to prognostic information and also pave the way to hypothesis driven treatment studies.